Why should I fill out this form?


Under current federal law, we are permitted to share information with you regarding our current Partnerships that may be available, but only if you are qualified to receive such information. The form below strictly limits us to asking questions of you that are specifically designed to make that assessment. You may be considered qualified based upon sole earnings, joint earnings, assets, certificates or licenses in securities, formal education, etc. You may be disallowed based upon many of these areas including past investment history or a proven inability to absorb and accept investment risk.
Please know that Mammoth Resource Partners, Inc. maintains the highest degree of privacy available today. Simply put, we do not share your information with any person or organization. We never have, and we never will.
After we receive your information, a licensed, Registered Representative will be assigned to you for dissemination of any information that you wish. Thank you for your understanding.
Contact Information
Thank you for your interest in Mammoth Resource Partners. We are permitted under federal law to share information on our partnerships only to qualified investors. Please complete the questionnaire below. You will be notified by a representative from Mammoth Resource Partners should you qualify as an accredited investor and/or a qualified purchaser. Again, thank you for your interest in Mammoth Resource Partners.

*Asterisk indicates required field

Do you currently have a Broker Dealer?

If so, please specify

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First Name:

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Last Name:

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Company Name:

Street Address:

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City:

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State/Province:

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Zip/Postal Code:

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Country:

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Work Phone:

 *5555555555

Home Phone:

 *5555555555

Fax:

Your E-mail:

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Education Experience
My Formal Education (School / Degree / Year Received)

Degree One:

Degree Two:

Degree Three:

I have one of the following licenses:

Do you believe that you have sufficient knowledge and experience in financial and business matters to evaluate the merits and risks of oil and gas partnerships?

Investment Information
U.S. Persons:  Are you or are you acting for a U.S. Person? (A US person is defined as an individual who is a national or permanent resident alien of the US and any corporation, business association, partnership, trust, or other judicial entity incorporated or permanently residing in the U.S.)

Yes No *
Accredited Investors (Choose A or B)

A. Individual Investors:Are you, in your capacity as an individual, rather than as an agent of a legal entity, an accredited investor?
  Yes No *
See below for a definition of an "Accredited Investor".
B. Entities: Are you an agent of a legal entity that is an accredited investor?
  Yes No *
See below for a definition of an "Entity" which is an "Accredited Investor".
Qualified Purchaser: Are you or are you acting for a "qualified purchaser"?
  Yes No *
See below for a definition of a "Qualified Purchaser".
What is your individual or joint total net worth? (May be combined with your spouse)
 
See below for a definition of "Net Worth".

Annual Earnings:

2007: Less than $200,000 $200,000 or more *
2008: Less than $200,000 $200,000 or more *
2009: Less than $200,000 $200,000 or more *
See below for a definition of "Annual Earnings".

Current Investments:

Hedge Fund:

Stocks:

Bonds:

Mutual Funds:

Gold / Silver:

Commodities:
If Financial Intermediary, which of the following are you?

How many years experience investing in oil and gas partnerships do you or your clients have?
 
By electronically signing below, I am affirming that all the information contained herein is true and correct to the best of my knowledge and belief.

Electronic Signature:

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*Asterisk indicates required field
Definitions

Annual Earnings:

Annual earnings” means adjusted gross income, as reported for federal income tax purposes, less any income attributable to a spouse, increased by the following amounts (but not including any amounts attributable to a spouse or to property owned by a spouse), (i) the amount of any tax exempt interest income received;

(1) the amount of any losses claimed as a partner in a partnership;

(2) any deductions claimed for depletion;

(3) amounts contributed to an ira or keogh retirement plan;

(4) alimony paid; and

(5) any amount by which income from long-term capital gains has been reduced in arriving at adjusted gross income pursuant to the provisions of section 1202 of the internal revenue code of 1954, as amended.

Accredited Investor:

You are an accredited investor if any one of the following are true:

1) Your individual net worth, or joint net worth with spouse, at the time of this purchase exceeds $1,000,000.

2) You had an individual income in excess of $200,000 in each of the two most recent years and reasonably expect an income in excess of $200,000 in the current year.

3) You and your spouse have had joint income for the most two recent years in excess of $300,000 and expect your joint income to be in excess of $300,000 for the current year.

Net Worth:

The fair market value of all assets, excluding home, furnishings and personal automobiles.

Qualified Purchaser:

The fair market value of all assets, including home, furnishings and personal automobiles is or exceeds $500,000.